Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0960 | NC |
NPI | 1043339070 |
---|---|
Provider Name | Pamela K Edgar Wells |
First Address | Charlotte, NC 28226-6808 |
Second Address | Charlotte, NC 28226-3197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 12/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12744 | BCBS (01) | NC |
7301422 | (05) | NC |